What is AERD/Samter’s Triad?
Aspirin Exacerbated Respiratory Disease (AERD), also known as Samter’s Triad or Aspirin Sensitive Asthma, is a chronic medical condition that consists of asthma, recurrent sinus disease with nasal polyps, and a sensitivity to aspirin and other non-steroidal anti-inflammatory drugs (NSAIDs). Approximately 10% of all adults with asthma and 40% of patients with asthma and nasal polyps are sensitive to aspirin and NSAIDs.
What are the symptoms?
Patients with AERD/Samter’s Triad usually have asthma, nasal congestion, and nasal polyps, and often do not respond to conventional treatments. Many have experienced chronic sinus infections and can lose their sense of smell. The characteristic feature of AERD/Samter’s Triad is that patients develop reactions triggered by aspirin or other NSAIDs.
These reactions can include:
- Increased nasal congestion or stuffiness
- Eye watering or redness
- Cough, wheezing, or chest tightness
- Frontal headache or sensation of sinus pain
- Flushing and/or a rash
- Nausea and/or abdominal cramping
- General feeling of malaise, sometimes accompanied by dizziness
If you not do have asthma, nasal congestion and/or nasal polyps but experience reactions to aspirin or NSAIDs, click here and here to learn about the Brigham and Women’s Aspirin and NSAID Allergy Clinic. The Aspirin/NSAID Allergy new patient packet can be found here.
A series of patients with AERD who developed COVID-19, including many who were treated with respiratory biologics for their baseline AERD, did not appear to experience increased morbidity compared to the general population with COVID19. This is reassuring to those with exacerbation-prone asthma and nasal polyps. It is intriguing that a strong type 2 inflammatory signal in the respiratory tract — a signal that the vast majority of patients with AERD exhibit — might actually be protective against severe COVID-19. Read more here.
As the director of one of the largest evaluation and treatment centers for patients with AERD in the world, Dr. Laidlaw is often asked how to approach the use of aspirin desensitization followed by high-dose aspirin therapy for patients with AERD in the current age of newly available biologics. In this perspective article, she describes a place for both treatment modalities, sometimes even both in the same patient at the same time. It is a set of decisions that need to be made on an individual patient basis — efficacy, safety, cost, and patient preference should be considered when approaching the decision and recommendation.
Chronic rhinosinusitis with nasal polyps (CRSwNP) is a common and heterogeneous inflammatory disease of the upper respiratory tract. Advances in our understanding of the immune mechanisms that drive the chronic respiratory inflammation that underlies CRSwNP have led to the generation of several targeted biologic therapies for this disease. However, the optimal evaluation and treatment strategy, including judicious use of systemic corticosteroids, allergen testing, proper surgical approach, appropriateness of antibiotics, and administration of newly approved biologics, is still hotly debated. Here we provide expert opinion and points of view from both allergists and rhinologists who specialize in CRSwNP, and the evaluation and management perspectives offered here are a consensus between the authors. Special consideration is given to patients with AERD, as they are a unique phenotype who often have the most severe disease symptoms. Read here.